To evaluate the clinical, electroencephalographic (EEG), neuroimaging characteristics, and treatment outcomes of patients diagnosed with eating epilepsy (EE). This retrospective study was conducted at a tertiary care epilepsy referral center in India. Patients diagnosed with EE between 2002 and 2025, with at least one EEG and magnetic resonance imaging (MRI) available for review, were consecutively included. Clinical data and multimodal evaluation findings including video EEG, brain MRI, positron emission tomography-MRI (PET-MRI), and magnetoencephalography (MEG) were systematically collected using a structured proforma. Seizure outcomes and treatment strategies were subsequently analyzed. A total of 50 patients (35 male) were included in this cohort, with a mean age at onset of epilepsy being 11.91 ± 8.18 years. All patients had drug-refractory epilepsy. Focal impaired consciousness seizure was the commonest seizure type (90%). MRI imaging was abnormal in 25 (50%), and the commonest finding was perisylvian gliosis. Patients with a history of perinatal insult (OR = 22.15, 95% CI: 2.58-189.95, p < 0.001) and intellectual disability (OR = 5.09, 95% CI: 1.45-17.92, p = 0.009) were more likely to have MRI abnormalities. Multimodal investigations most consistently implicated the perisylvian epileptic networks, as demonstrated by Video Electro Encephlaogram (VEEG) (52%), MRI (32%), PET-MRI (38.1%), and MEG (57.9%). Approximately one-fourth of the patients were seizure-free at their last follow-up. EE is a disabling form of reflex epilepsy with heterogeneous clinical, EEG and neuroimaging features, which are not necessarily substrate-specific. Findings from our study point to the presence of a wide epileptogenic network prominently involving perisylvian regions. Treatment outcomes in drug-refractory EE remain suboptimal, and further studies are needed for a better understanding and management of this complex entity.

Reflex epilepsies are rare syndromes where seizures are triggered by particular stimuli or activities that may be motor, sensory, or cognitive in nature. Eating-induced seizures are an uncommon presentation of reflex epilepsy. Many etiologies, including genetics, ethnicity, and specific foods and eating behaviors, are linked to eating epilepsy. In this case report, a 55-year-old man who was admitted to the neurology clinic with epileptic seizures that occurred many times after spicy meals is presented. His neurological examination and metabolic values were normal. MRI showed nonspecific white matter changes. An interictal active epileptic focus was detected in the left temporal region in interictal EEG. The patient was started on valproic acid treatment at 1,000 mg/day. Anti-seizure treatment controlled the seizures and normalized the EEG abnormalities. In this case report, it is emphasized that eating epilepsy should be considered in patients with a history of seizures induced with eating, and the diagnosis and treatment process of eating epilepsy is also mentioned.

A 22-year-old female presented with drug-resistant focal motor seizures with onset at age 14. This manifested as daily episodes of right facial dystonia triggered by toothbrushing, but also by eating, talking, and strenuous exercise. On ictal scalp EEG, there was low-voltage fast activity over the left pericentral area. Structural MRI did not identify a definite lesion. Functional MRI (fMRI) of a reflex seizure, as well as task-based fMRI during toothbrushing, both demonstrated focal activation at the left low pericentral cortex. Stereoelectroencephalography (sEEG) showed recurrent ictal trains of focal spiking concordant with the fMRI activation. Radiofrequency (RF) thermocoagulation was applied at the posterior bank of the left low pre-central gyrus, with post-operative MRI confirming small ablative lesions immediately deep to the ictal fMRI activation, and the patient remains seizure-free more than 3 years after this treatment. Toothbrushing epilepsy is a rare form of reflex epilepsy where seizures are induced by toothbrushing. In this unique case, ictal fMRI assisted targeting of the sEEG implantation, to confirm seizure onset and enable minimally invasive treatment via RF thermocoagulation, resulting in seizure freedom.

Eating epilepsy is a rare condition in children where seizures are triggered by the act of eating. An eight-year-old girl presented with seizures occurring primarily during mealtimes, characterized by a fixed gaze, jaw hypotonia, and impaired awareness. These seizures began at age seven, were initially uninvestigated, and progressively worsened over the year, reaching up to 20-30 episodes per meal. Diagnostic tests, including blood work, upper gastrointestinal endoscopy, psychiatric evaluation, and magnetic resonance imaging (MRI), were normal. The EEG showed generalized epileptiform activity, suggesting a seizure disorder, but the exact cause was unclear. After ruling out more common conditions with similar symptoms, such as gastroesophageal reflux disease, Sandifer syndrome, and psychogenic non-epileptic seizures, the diagnosis of reflex eating epilepsy was made in the end through a process of elimination, combining clinical features with EEG findings and through reviewing the literature. Treatment with oral sodium valproate monotherapy led to significant symptomatic improvement, reducing the frequency of seizures during meals.